Suicide in Doctors: those who care for the lives of others also end their own..
A recent article in the New York Times by Pranay Sinha, a physician in his first year of residency in the department of internal medicine at Yale-New Haven Hospital describes how a few weeks ago in mid-August, two medical residents in their second month of residency training in different programs, jumped to their deaths in separate incidents in New York City. Sinha did not know them and does not presume to speak for them or their circumstances. But he imagines that they had celebrated their medical school graduation this spring just as his friends and he did. He imagines they began their residencies with the same enthusiasm for healing as he did. And he imagines that they experienced fatigue, emotional exhaustion and crippling self-doubt at the beginning of those residencies — as he says himself: “I know I did”.
This sad story reiterates the well-established fact that doctors are at higher risk of dying by suicide than the general population. Whilst it is usual for those on both sides of the Atlantic to emphasize the differences between the US and UK health systems, it is highly likely that, whilst the journeys of fatigue, blasted morale, burnout and depression may be different, the destinations are very much the same. It is imperative therefore that every effort is made to tackle any and all the preventable causes of needless suffering and death, this being even more the case in the light of the need for healthcare services to model and practice the best examples possible for the wider society to follow; excellent progress has been made with smoking, it can be similarly achieved in tackling the toxic fumes associated with occupation.
Sinha cites the following concerning facts: “Physicians are more than twice as likely to kill themselves as Nonphysicians (and female physicians three times more likely than their male counterparts). Some 400 doctors in the US die by suicide every year. Young physicians at the beginning of their training are particularly vulnerable. In a recent study, 9.4 percent of fourth-year medical students and interns — as first-year residents are called — reported having suicidal thoughts in the previous two weeks.”
It is more difficult to establish the true figures in England because those that are available are very out-of-date, do not include occupation and are variably labelled as suicide dependent on the practices of individual Coroners; the figures quoted in the National Suicide Prevention Strategy are from a 2007 study that cites figures from 2001. More recent studies of suicide and occupation have been undertaken in Denmark and England, although the Denmark study figures are from 1997-2007.
Action for NHS Wellbeing member Martin Seager comments on the NYTimes article: “this is a very well-written and moving article. If this is correct that female doctors kill themselves significantly more than males then this bucks the usual trend of male dominated suicide and this could help us to understand even better the gender factors that lie behind suicide. My guess is that the three great rules of masculinity:
3. Mastery-control are in fact also the rules of doctoring and even become magnified in that context. This may mean that male doctors are more used to struggling with these rules from childhood as male people but that female doctors get a double whammy as these rules are more alien to them so harder to live up to. This is something that badly needs to be researched. It may also be the case that, as more women enter the profession, there will be less prejudice against them and more peer-peer support and/or the rates will increase in men to the same level as women as both sexes experience the increasingly pressurising industrialised healthcare system that tends to eviscerate care.
A further recent study from Australia: Kõlves, K; De Leo, D. (2013) Suicide in medical doctors and nurses: An analysis of the Queensland Suicide Register.Journal of Nervous and Mental Disease, 201: 987-990 aimed to estimate the risk for suicide among medical doctors and nurses compared with the education professions and the general population and to describe the characteristics of their suicides. Suicide cases and rates in the age group of 25 to 64 years were analyzed using the Queensland Suicide Register (QSR) during 1990 to 2007. The male medical doctors had lower suicide rates than those of the male education professionals and significantly lower rates than those of the general population. The female medical doctors had significantly higher rates than those of the education professionals, but the rates were similar to those of the general population. Among the nurses, both sexes had significantly higher rates than those of the education professionals; however, their rates were similar to those of the general population. Poisoning was used significantly more often by the medical professionals (59.3%) and the nurses (44.1%) than by the education professionals (23.5%) and others (18.8%). Depression was more common in suicide of the medical doctors than the nurses, the education professionals, and others. Work-related problems were most prevalent for the medical doctors (18.5%) followed by the education professionals (16.5%).
Action for NHS Wellbeing member Dr Alastair Dobbin qualifies this further by comparing this study with estimates obtained from the National Survey of Mental Health and Wellbeing 2007 (NSMHW, 2007), in which the level of very high psychological distress was significantly greater in doctors in comparison to the general population and other professionals (3.4% vs. 2.6% vs. 0.7%). The comparison figures are from 2013 for medics, but appear to be from 2007 for the other professions and so we do not know their burnout and depression/anxiety rates now. “Once again the suicide rates are very old. The Queensland study is based on 1996-2006 data, and the Hawton study of Danish Physicians, although dated 2011 (publication date) is actually based on figures from 1997 – 2007.”
Action for NHS Wellbeing member Dr Paul Davies suspects that the figures will be worse in the UK than Australia given that they have not (yet) experienced a recession and (still) have a far better-resourced healthcare system. He cites the recent survey of over 14,000 doctors and medical students conducted by the Doctors Mental Health Programme of Beyondblue (bbDMHP), a not-for-profit Australian organisation focused on anxiety and depression and reducing the stigma associated with both.
The key objectives of the survey were to:
- better understand the issues associated with the mental health of Australian medical students and doctors.
- increase awareness across the medical profession and broader community of issues associated with the mental health of medical students and doctors.
- inform the development of mental health services, programs and support for medical students and doctors to address the prevalence of depression and anxiety.
The key findings were:
- One in five medical students and one in 10 doctors had suicidal thoughts in the past year. This compared with one in 45 people in the wider community.
- More than 40 percent of medical students and more than a quarter of doctors are highly likely to have a minor psychiatric disorder. The survey found medical students and young, female or overseas-trained doctors were most at risk.
- Almost 6 percent of doctors under the age of 30 were experiencing very high psychological distress – more than twice the rate of the general population of that age.
- Of specialists, oncologists suffered the most distress, with more than a third highly likely to have a minor psychiatric disorder, while emergency doctors, surgeons and anaesthetists were most likely to drink alcohol at risky levels.
Action for NHS Wellbeing is determined to keep pressing on issues such as this that are relevant to the quality of life and safety of all those working in and for the NHS, so that the figures and studies that we have on all occupations are not so ‘laggy’ – especially in professions where OUR health and life depend on the levels of functioning and wellbeing of these people.